The COVID-19-induced lockdown and restricted lifestyle that followed have heightened our sense of loneliness, fear, depression, and anxiety. Research over the past few months in the United States and other high-income countries have corroborated this phenomenon–increased stress and physiological distress have grappled a large proportion of the population.
Suicide is preventable but it’s also a complex and multi-faceted issue, and accounts for more than 800,000 lives lost across the world every year. For more than a decade, suicide has consistently been the second leading cause of death for adolescents and adults 15 to 29 years of age; the numbers continue to rise. Further alarmingly, teen and adolescent suicides increased in the U.S. by 56% in the past two decades. However, it is important to acknowledge that suicide disproportionality affects low- and middle-income countries (LMICs). In 2016 for instance, 79% of all suicides occurred in LMICs. What is more concerning is that a prior suicide attempt is the most common risk factor for suicide, and for every individual who dies by suicide, there are at least 20 more suicide attempts.
Research has shown that suicide does not discriminate by gender, race, or socio-economic status. Mental and behavioral disorders, alcohol and substance abuse, and chronic pain are among other main risk factors associated with suicide. Economic and financial crises or difficulties can also lead individuals to develop mental and behavioral problems due to feelings of uncertainty and increased stress. More recently, the COVID-19 pandemic — combined with systemic problems such as racism, poverty, discrimination, and oppression — has created a unique and overwhelming combination of risk factors to suicide.
The increase in suicide rates intensifies in part due to health systems deficiencies such as lack of accessible resources in the form of counseling, mental health services, and treatment and in part due to societal and communal issues such as stigmatization, inappropriate media coverage, and stressors that come with certain cultures. Access to treatment and supportive, safe spaces for sharing are not available for adolescents in many settings, creating a challenge to drive change in how suicide and related circumstances are viewed. These barriers also affect other vulnerable populations such as the elderly, females, individuals with mental disorders, disabled people, ethnic and indigenous groups, migrants, and refugees disproportionately making them more susceptible to suicide.
Globally, three times as many males die of suicide compared to women, however, this gap is much lower or even inverse in LMICs, and research has shown substantial variations across regions and countries. Cultural and social norms, pre-established gender roles, financial disparities, and domestic violence are potential drivers of this gender association in low resource settings.
Organizations in the United States, such as the Center for Disease Control and Prevention and National Institute for Mental Health, have developed overarching prevention strategies for suicide that range from strengthening economic support, access and delivery of care, creating safe and protective environments, promoting connectedness, teaching coping and problem-solving skills, identifying and supporting people at risk, and reducing harm and preventing future risk. As recent research has highlighted, the prevalence of suicidal ideation and suicide-associated risk factors of depression, anxiety, stress, and mental disorders at much younger ages, identification of such risk factors, and subsequent treatment, as well as prevention are key to shifting the ever-increasing paradigm of suicide amongst children. Additionally, policies have been put in place to limit access to pesticides, drugs and medications and have shown reduction in suicide rates in some countries.
Yet, around the world, many LMICs lack the appropriate foundation of evidence-based systems to address suicide. Many of these programs can be implemented across various groups within the community, such as students, teachers, counselors, parents, and peers, and across different work settings – helping to build a cadre of “first responders” who could identify individuals at risk and avail necessary services. Raising community awareness and providing adequate data on suicide across the globe are essential in breaking down the barriers individuals encounter when deciding whether or not to seek mental health care in their community. Education about risk factors and warning signs of suicide and suicidal ideation requires a coordinated and comprehensive public health approach. With a clear unmet need for treatment in LMICs, there is an opportunity to model the existing prevention strategies into regionally and culturally appropriate prevention tactics applicable to these settings.
More recently, the World Health Organization (WHO) implemented its Special Initiative for Mental Health (2019-2023), dedicated to ensuring access to quality and affordable care for mental health conditions with a goal of reaching 100 million people. WHO intends to advance mental health policies, advocacy, and human rights through evidence-based interventions, and is aimed at providing quality mental health services through community-based and general health and specialist settings. Additionally, promoting mental health and well-being is a part of one of the Sustainable Development Goals, targeted to be achieved by 2030.
Perhaps now, more than ever, it’s critical that we acknowledge the need and urgency for suicide prevention interventions at the global level and work tirelessly to reduce the suffering by those affected. The Johns Hopkins International Injury Research Unit family of faculty, staff, and students know and recognize the tragic reach caused by suicide around the world and encourage all to ask “what can we collectively do to prevent suicide?”
One initiative to help counter this gap is the Adolescent Violence and Injury Detection System (AVID), an innovative research project set up in India and Vietnam to develop and implement a community-based system for early detection of adolescents at risk and link them to appropriate service providers, as well as avail support. Through proven, evidence-based measures, we see a path to lives saved and families changed for the better.
If you are in the U.S. and you or someone you know is struggling, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit www. Suicidepreventionlifeline.org for more information.
This blog post was co-authored by Johns Hopkins International Injury Research Unit Director Dr. Abdul Bachani, Research Associates Drs. Priyanka Agrawal and Lamisa Ashraf, and Program Coordinator Abigail Green.